Employment Verification Form - Prometric - ct 2025

1. Click ‘Get Form’ to open the Employment Verification Form in the editor.
2. Begin by entering your name, current address, telephone number, and email address in the designated fields. Ensure all information is accurate for verification purposes.
3. Input your Connecticut Nurse Aide Registration Number and Social Security Number in the respective fields. This information is crucial for your identification.
4. Indicate if you are certified as a nurse aide in any other states. If yes, list those states in the provided space.
5. Next, have your employer complete their section. They will need to provide the facility or agency name, address, employer code (if applicable), date of hire, last reported date of employment, and termination date if applicable.
6. Finally, ensure that an employer representative signs and dates the form before submission. This step is essential for validation.

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